[Treatment of coronary pseudoaneurysm by stent-graft implantation]

A 54-year-old man was urgently admitted because of sudden onset of progressively worsening angina pectoris, his first attack. Physical examination was unremarkable.

Electrocardiography and laboratory tests excluded acute myocardial infarction. With the exception of hypercholesterolemia (total cholesterol 247 mg/dl) laboratory tests were normal. Coronary angiography revealed a 60% eccentric narrowing in the proximal part of the interventricular branch with adjacent aneurysmatic dilatation. Intravascular ultrasound (IVUS) showed a coronary pseudoaneurysm, its cavity communicating with the empty atheroma hole of an adjacent ruptured coronary plaque.

A 19 mm stent graft was implanted, via a percutaneously inserted balloon-catheter system, in the region of the stenosis and the pseudoaneurysm. Subsequent angiography demonstrated a smooth nonstenotic lumen. The membrane of the graft (made of polytetrafluoroethylene [PTFE]), fixed between two thin metal stents, had occluded the pseudoaneurysm. Occlusion of an immediately distal septal branch briefly produced an asymptomatic rise of creatine kinase to maximally 173 U/l. Oral medication included ticlopidine hydrochloride (2 x 250 mg daily for 4 weeks). The patient was symptom-free after the procedure and was discharged 5 days later.

Implantation of a new type of stent-graft provides quick and uncomplicated treatment of a coronary aneurysm. The membrane fixed between two stents prevents wash out of any thrombi. The method may also be applicable to other potentially thrombus-containing lesions.